Correctional Nurse Legal Briefs - Medical Rights of Estelle v. Gamble

In a prior post I have described the practice impact of the Supreme Court decision on Estelle v Gamble in 1976; in particular, deliberate indifference and serious medical need. In this post, I want to dig deeper into the basic rights that were established by this precedent-setting decision. Many court cases over the ensuing 40 years have unpacked these rights and further described them. While reading these descriptions, consider how your nursing practice is affected by the basic principle underlying the right.

Access to Medical Care

The first provision of the Supreme Court ruling is the basic right to medical care access. If an inmate needs medical attention, this cannot be denied. There are many ways in which medical care can be passively denied. Barriers to care can be found in the structure and process of security services and health care delivery systems. For example, a facility may not have enough health care staff to meet the needs of the inmate population. If patients must wait weeks to be seen by a practitioner for an urgent condition, access to care is being hindered. This provision also covers specialists and inpatient treatment. If the medical care needed for a condition cannot be provided by onsite staff, adequate and timely access to specialists must be provided.

Care that Was Ordered

If medical staff determine that a treatment is needed and an order for the treatment or medication is written, it must be honored. Security staff or internal processes cannot hinder the required treatment nor can treatment be countermanded. Of course, accommodation of security concern is understood to be foundational and collaboration with custody staff is needed to deliver medical care in our setting. An example of abridgement of this right would be for custody staff to require an inmate to report to work duty when bed rest was ordered for treatment of a sprained ankle. What Estelle v. Gamble imposes, then, is a legal duty on the part of the custodial authority to honor medical orders.

A Medical Judgment

The third medical right for inmates garnered by Estelle v Gamble is a right to a professional judgment. This right covers the need for appropriate health care staff to assess and determine medical care required by an inmate. The courts wanted to be sure that decisions about medical care are based on medical need and not on security need or convenience. For example, necessary care cannot be denied due to budgetary constraints or as a punishment. Healthcare staff cannot avoid a patient because he or she is a complainer or is obnoxious. Inmates, unlike free citizens, are not able to access other sources of care if they are not getting their needs met when incarcerated. The courts want to ensure that this does not adversely affect them. This right has significant implications for correctional nurses. Inmates cannot be avoided or disregarded because they are labeled as ‘trouble-makers’ or ‘manipulators’. Treatment cannot be denied because it is too expensive for the budget. This is not to eliminate efforts to be as cost-effective as possible in providing adequate care, however.

How have you seen these three primary medical rights of inmates implemented at your facility? Share your thoughts in the comments section of this post.

Guest post by Dr. Lorry Schoenly nurse author and educator specializing in the field of correctional health care. She has written 6 continuing education courses especially for the Correctional Healthcare Campus.